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Pediatric Rheumatic Heart Disease in a Middle-Income Country: A Population-Based Study
Norazah Zahari1, Si Ling Yeoh2, Siva Rao Muniandy2
1Department of Pediatrics, Faculty of Medicine, University of Malaya, 59100 Kuala Lumpur, Malaysia.
Insights
Pediatric Rheumatic Heart Disease (RHD) is rising in Sabah, with most cases severe at diagnosis. This highlights the need for early screening and national programs to combat this debilitating condition.
Area of Science:
- Cardiology
- Pediatrics
- Public Health
Background:
- Rheumatic heart disease (RHD) is a serious complication of rheumatic fever, disproportionately affecting low- and middle-income countries.
- Pediatric RHD presents a significant public health challenge, necessitating detailed epidemiological studies.
Purpose of the Study:
- To describe the incidence, prevalence, and modifiable risk factors for severe pediatric RHD.
- To evaluate the immediate outcomes of pediatric RHD cases.
Main Methods:
- A population-based, observational cohort study.
- Data collected from the Sabah Pediatric Rheumatic Heart Registry (2015-2018).
- Reviewed 188 pediatric RHD patients (0-18 years).
Main Results:
- RHD incidence: 2.19 per 100,000; prevalence: 13.78 per 100,000 pediatric population, with a rising trend.
- Majority of patients were indigenous, male, from low-income households, and lived in crowded conditions.
- 59% diagnosed with severe RHD; severe RHD associated with increased risk for intervention (p=0.016).
Conclusions:
- Rising pediatric RHD incidence and prevalence in Sabah, with a high proportion of severe cases at diagnosis.
- Urgent need for echocardiographic screening and a comprehensive national RHD control program.
Introduction:
Rheumatic heart disease (RHD), a debilitating complication from rheumatic fever, remains a problem in low- and middle-income countries. This study describes the incidence, prevalence, modifiable risk factors for severe RHD and immediate outcome of pediatric RHD.
Methods:
This population-based and observational cohort study reviewed pediatric RHD patients (0-18 years) from the Sabah Pediatric Rheumatic Heart Registry from 2015 till 2018.
Results:
A total of 188 RHD were reviewed with 120 new cases. The incidence of RHD is 2.19 [95% confidence interval (CI): 1.83-2.61] per 100 000 population, with a rising trend over time. Meanwhile, the prevalence of RHD was 13.78 (95% CI: 11.92-15.86) per 100 000 pediatric population. The majority of patients were from indigenous groups (59.0%), male (56.4%) with a mean age of 14.3 (3.31) years. About 77.9% had the lowest household income, and a significant proportion lived in overcrowded conditions. At diagnosis, 59% were diagnosed with severe RHD. There is heightened risk but no statistical significance between modifiable factors (low weight and height percentile at diagnosis, lowest income group, renting a house, overcrowding and healthcare access of more than 5 km) with severe RHD. Severe RHD is significantly associated with risk for intervention (p = 0.016). Sixteen (13.8%) patients required surgical intervention. About 97.6% of patients were on intramuscular benzathine penicillin G with 84.5% compliance.
Conclusion:
The rising prevalence and incidence of pediatric RHD in Sabah, with the most being severe RHD at diagnosis, necessitates the development of an echocardiographic screening and a comprehensive national disease program.
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